Production of treponemicidal concentration of penicillin in cerebrospinal fluid.

Dunlop, E. M. C.; Al-Egaily, S S; Houang, Elizabeth T.

doi:10.1136/bmj.283.6292.646

Cited by 35 publications

(13 citation statements)

References 4 publications

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“…69 Procaine penicillin injections also achieve treponemicidal levels in CSF, and there is evidence of clinical improvement in some studies, but the regimen is often difficult to complete because of the need for multiple intramuscular injections that can be painful and the requirement for adherence to oral probenecid 4 times daily. 70,71…”

Section: Resultsmentioning

confidence: 99%

Treatment of Syphilis

Clement

Okeke

Hicks

2014

JAMA

233

102

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Section: Resultsmentioning

confidence: 99%

Treatment of Syphilis

Clement

Okeke

Hicks

2014

JAMA

233

102

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“…. In small studies, a number of ceftriaxone regimes have been shown to be effective 84 days of procaine penicillin (plus probenecid 500 mg PO QDS for the same duration) is the favoured outpatient regime dose in the CDC 2010 guidelines 3 as it has been shown to produce treponemicidal levels in the CSF, 99 although this may be an inconsistent finding. 100 It is likely that lower doses of procaine penicillin are as efficacious.…”

Section: Recommendationmentioning

confidence: 99%

“…98 Cardiovascular and neurological lesions may progress despite adequate treatment for syphilis. Steroids should be given with all anti-treponemal antibiotics for neurological and cardiovascular syphilis. For neurosyphilis 2.4 g (2.4 MU) intramuscular (IM) once daily (OD) for 10–14 days of procaine penicillin (plus probenecid 500 mg orally (PO) four times a day (QDS) for the same duration) is the favoured outpatient regimen dose in the CDC 2010 guidelines 3 as it has been shown to produce treponemicidal levels in the CSF, 99 although this may be an inconsistent finding . 100 It is likely that lower doses of procaine penicillin are as efficacious .…”

Section: Management: General Considerationsmentioning

confidence: 99%

UK national guidelines on the management of syphilis 2015

Kingston¹,

et al. 2015

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These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline.

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“…The improved therapeutic results (Craft et al, 1979;Dacey and Sande, 1974;Dewhurst, 1969;Dunlop et al, 1979) have been confIrmed in very recent studies, which show the critical role of probenecid in assuring adequate cerebrospinal fluid levels of penicillins to cure neurosyphilis after administration of aqueous benzylpenicillin (Polnikorn et al, 1980) or procaine penicillin (Dunlop, 1981).…”

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confidence: 95%

Clinical Pharmacokinetics of Cerebrospinal Fluid

Bonati

Kanto

Tognoni

1982

Clinical Pharmacokinetics

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The distribution of drugs into the cerebrospinal fluid has long been considered a challenging field of investigation in 2 major respects: (a) understanding how the physicochemical properties (molecular weight, pKa, plasma protein binding) of various molecules influence their movements across such a specific structure as the blood-brain barrier; and (b) defining the relationship between cerebrospinal fluid concentrations of various drugs and their central (side) effects. An attempt has been made to review the very dispersed information presently available to offer a clinically orientated picture of this area of pharmacokinetics. Drugs acting on the central nervous system (benzodiazepines, tricyclic antidepressants, anticonvulsants, opioids), antibacterial agents, cardiovascular drugs (beta-adrenoceptor blockers and digoxin), antineoplastic drugs (mainly methotrexate), and other miscellaneous agents (corticosteroids, cimetidine, methylxanthines) are reviewed. The available evidence seems to support the conclusion that only for methotrexate and antibacterial agents does knowledge of cerebrospinal fluid pharmacokinetics have direct therapeutic implications, while the mosaic of information available for other drugs does little more than provide a partially satisfactory picture.

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Production of treponemicidal concentration of penicillin in cerebrospinal fluid.

Cited by 35 publications

References 4 publications

Treatment of Syphilis

Treatment of Syphilis

UK national guidelines on the management of syphilis 2015

Clinical Pharmacokinetics of Cerebrospinal Fluid

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